Exercise-attenuation of Q-waves in II, III, and aVF, and R-Waves in V1 and V2 in a patient with an inferior infarction and anterior wall ischemia.
A 63-year-old male patient with inferior infarction revealed transient attenuation of the Q-waves in II, III, and aVF, and R-waves in V1-V3 during an exercise stress test. Myocardial scintigraphy disclosed ischemia of the anterior wall and coronary arteriography, a 90% stenosis of the left main coronary artery (LMCA). The mechanism involved appears to be a transient failure of the anterior wall to generate adequate depolarization forces for the genesis of Q-waves in the inferior leads and R-waves in the anterior leads. This electrocardiogram sign is diagnostic of severe anterior wall ischemia due to left anterior descending or LMCA stenosis.
Madias
John E
JE
Mount Sinai School of Medicine, New York University, Elmhurst, New York, USA. madiasj@nychhc.org
D023921:Coronary Stenosis / Q000175:diagnosis* / Q000209:etiology*; D004562:Electrocardiography / Q000379:methods*; D005080:Exercise Test; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis*; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000175:diagnosis*